Lifetime Achievement Award Welcome to the Lifetime Achievement Award Nomination Form. Before submission, we recommend making a copy of the answers provided on the form so that they will not be lost in case of technical difficulties. Upon submitting the form, you will receive a confirmation message. If no message displays, please contact the organization to firstname.lastname@example.org. LanguageINFORMATION ABOUT NOMINATOR Full name*More than one name may listed. Email*Please, provide one single email address. This will serve as the primary contact point for any communication between LACNIC and the nominators. Professional relation to the Nominee*Reasons why the candidate is being nominated*INFORMATION ABOUT THE NOMINEEFull name*Country of birth*Mobile*Email* Years of experience working in the Internet field*ReferencesImpact*Explain the impact of the candidate's work on Internet growth or development in LAC.Influence on others*Briefly explain the candidate's influence on 1) the work of others within the same field, 2) society in general, or 3) other groups, regions or communities.Innovation*Briefly explain any innovative/creative work, actions or events that have contributed to forging new roads, establishing new paradigms, clearing obstacles, or accelerating the progress of the Internet. Scope*Briefly explain the scope of the candidate's work among society in general or among key groups within specific communities. Career highlightsCommentsOptionalIf available, please upload a CV or Resume for the Nominee.NameThis field is for validation purposes and should be left unchanged.